What is the correct CPT (Current Procedural Terminology) code for a percutaneous pyelolithotomy with dilation and basket extraction of a 1 cm kidney stone?

CPT Code Selection for Percutaneous Pyelolithotomy with Dilation and Basket Extraction

The correct CPT code for a percutaneous pyelolithotomy with dilation and basket extraction of a 1 cm kidney stone is 50080. 1

Understanding CPT Code Selection for Kidney Stone Procedures

The selection of the appropriate CPT code for percutaneous kidney stone removal depends primarily on the size of the stone being removed:

• 50080: Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm
• 50081: Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm

Key Factors in Code Selection

1. Stone Size: The primary differentiating factor between codes 50080 and 50081 is the stone size

   • The case involves a 1 cm stone, which falls under the "up to 2 cm" category
   • Therefore, 50080 is the appropriate code 1

2. Procedure Components: Both codes include:

   • Percutaneous access
   • Dilation of the tract
   • Endoscopic visualization
   • Basket extraction
   • Potential stenting

3. Anatomical Location: Both codes cover procedures performed in either:

   • The renal pelvis (pyelostolithotomy)
   • The kidney calyces (nephrostolithotomy)

Why Other Codes Are Incorrect

• 50040: This code represents percutaneous nephrostomy, nephrolithotomy, or pyelostolithotomy without endoscopy - not appropriate when endoscopy and basket extraction are performed
• 50081: This code is for stones larger than 2 cm - our case involves a 1 cm stone
• 50130: This code represents pyelotomy with removal of calculus (open surgical approach) - not appropriate for a percutaneous procedure

Clinical Context and Importance

Percutaneous stone removal has become the standard of care for many kidney stones, with the American Urological Association recommending percutaneous approaches for stones that cannot be effectively treated with less invasive methods 1. The procedure typically involves:

1. Percutaneous access to the kidney under fluoroscopic guidance
2. Tract dilation to 24-30 French
3. Use of rigid or flexible nephroscopy for stone visualization
4. Stone fragmentation if necessary
5. Basket extraction of stones or fragments
6. Placement of a nephrostomy tube for drainage

This approach offers several advantages over open surgical techniques, including:

• Smaller incision (approximately 1 cm)
• Reduced hospitalization time
• Minimal postoperative morbidity 2

Potential Complications to Document

When coding this procedure, be aware of potential complications that may require additional codes:

• Bleeding requiring transfusion (occurs in 4-15% of cases)
• Infection or sepsis (occurs in approximately 4% of cases)
• Catheter-related issues including displacement or occlusion
• Pleural complications in approximately 1% of cases 3

By selecting CPT code 50080 for this 1 cm stone removed via percutaneous pyelolithotomy with dilation and basket extraction, you are accurately representing the procedure performed.